腹腔镜经肛门柱状切除术在低位直肠癌的临床运用价值

目的 探讨腹腔镜经肛门柱状切除术在低位直肠癌的临床运用价值。 方法 选取2014年9月-2015年8月浙江大学金华医院收治的低位直肠癌患者56例作为研究对象,按照手术方式的不同分为观察组(26例)和对照组(30例)。观察组采用腹腔镜经肛门柱状切除术,对照组采用腹腔镜下腹会阴联合直肠癌根治术。对比2组的手术时间、失血量、清扫淋巴结数、引流量。记录2组的术中环周切缘阳性及直肠穿孔例数。随访12个月,记录2组患者的并发症(骶前血肿、尿潴留、下肢静脉血栓)发生情况、复发、1年生存率。 结果 观察组手术时间[(179.38±28.17) min]显著高于对照组[(150.46±21.35) min],失血量[(121.52±32.63) ml]显著低于对照组[(172.41±43.17) ml],差异有统计学意义(P<0.05)。2组清扫淋巴结数、引流量对比,差异无统计学意义(P>0.05)。观察组环周切缘阳性(0.00%)、直肠穿孔例数(0.00%)显著低于对照组(20.00%、23.33%),差异有统计学意义(P<0.05)。2组并发症发生率(11.54% vs.13.33%)、1年生存率(84.62% vs.76.67%)对比,差异无统计学意义(P>0.05);观察组复发率(7.69%)显著低于对照组(33.33%),差异有统计学意义(P<0.05)。 结论 腹腔镜经肛门柱状切除术治疗低位直肠癌,能降低环周切缘阳性及直肠穿孔的发生率,有助于降低复发率。 

Laparoscopic assisted transanal cylindrical resection of low rectal cancer

Objective To investigate the clinical value of laparoscopic assisted transanal cylindrical resection in patients with low rectal cancer. Methods Total 56 patients with low rectal cancer in our hospital from September, 2014 to August, 2015 were selected as the research object and divided into observation group (n=26) and control group (n=30) according to the surgical methods. The observation group received laparoscopic assisted transanal cylindrical resection, while the control group received laparoscopic abdominoperineal resection. The operation time, blood loss, number of lymph nodes and drainage volume were compared between the two groups. The number of cases with positive resection margin and perforation in the two groups were recorded. All patients were followed up for 12 months; the incidence of complications (Presacral hematoma, urinary retention, and lower extremity venous thrombosis), relapse rate, and 1-year survival rate were compared between the two groups. Results The operation time[(179.38 ±28.17) min] in the observation group was significantly higher than that in the control group[(150.46 ±21.35) min], and the blood loss[(121.52 ±32.63) ml]was significantly lower than that of the control group[(172.41 ±43.17) ml], the difference was statistically significant (P<0.05). There was no significant difference in the number of lymph nodes and volume of drainage between the two groups (P>0.05). Positive circumferential resection margin (0%) and rectal perforation (0%) in the observation group were significantly lower than those in the control group (20% and 23.33%), the difference was statistically significant (P<0.05). The incidence of complications in the observation group was 11.54% and in the control group was 13.33%, the 1-year survival rate in the observation group was 84.62% and in the control group was 76.67%, there was no significant difference (P>0.05). The relapse rate in the observation group (7.69%) was significantly lower than that of the control group (33.33%), the difference was statistically significant (P<0.05). Conclusion Laparoscopic assisted transanal cylindrical resection of rectal cancer can reduce the incidence of positive circumferential resection margin and rectal perforation, which is helpful to decrease the relapse rate of rectal cancer.